Improvement Academy

Quality Tools

There are several tools that are available to staff engaged in quality improvement. Use of the tools enables teams to gain a better understanding of the underlying problems that are causing the issue, gain insight as to how best to go about the improvement and develop an effective strategy to complete your project.  

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There are many other tools that are available to assist you with your improvement work. Please review the attached improvement science cheat sheet developed by the Clinical Excellence Commission.

For more information about quality tools you can visit the Clinical Excellence Commission Quality tools page and refer to the Institute for Healthcare Improvement Quality Improvement Essentials Toolkit

An overview of some of the more commonly used tools are listed below:

A flow chart maps the sequence of events in a process.  It provides a visual picture of the process being studied. It can be used when:

  • A team begins to study a process
  • Searching for improvement opportunities
  • Designing an improved process
  • Training people in a process

There are two main types of flow charts:

High level flow chart (macro)

  • A diagram that describes the overall process

Low level flow chart (micro)

  • A diagram that provides more detail to the major steps of the high level flow chart. 

To create a flowchart, teams brainstorm all the steps in the process as it currently exists. Teams write each process step in a box (or on a sticky note). In addition to the steps themselves, they use a diamond shape (or sticky note turned on its corner) to indicate points in the process where a decision needs to be made. For decision steps, the team writes a yes/no question. Then they use lines to show the connections between the boxes and diamonds.

You can find more information on how to construct a flow chart on the IHI Flow Chart Cheat Sheet

Brainstorming is a method used for generating a large number of creative ideas in a short period of time. It is useful when:

  • Participation of the entire group is desired
  • Creative or original thinking is sought after
  • A broad range of options is desired

An easy way to complete this process is for team members to write down their ideas/thoughts on sticky notes – one issue per sticky note.

You can find more information on how to construct a flow chart on the CEC Quality Tools page

Affinity diagrams are a tool that assist with gathering and organising ideas generated by a team. They are helpful in simplifying complicated issues into broad categories. Ideas generated through brainstorming are read and themed by the team. Each theme/group of ideas is given a header or title which is placed on a new sticky. Any double ups are removed.

After a brainstorming session teams silently read and arrange stick notes into categories.

The Cause and Effect Diagram also known as the Ishikawa or fishbone diagram, helps analyse the root causes contributing to an outcome. It graphically displays the relationship of the many causes contributing to an outcome

A Cause and Effect Diagram can contain the same information as a Cause and Effect Diagram, but is displayed in a different format. This can be useful in appealing to the way different people learn.

You can find more information on how to construct a flow chart on the IHI Cause and Effect Cheat Sheet.

Tally sheets provide a simple way of collecting data in real time and at the location where the data is generated. The document is typically a blank form that is designed for the quick, easy and efficient recording of frequency.

Steps for designing and using a tally sheet:

  1. Decide on area and category of performance or problem to be solved
  2. Design a simple form or collecting method
  3. Agree on time period for collection
  4. Trial tool
  5. Train people on how to use tool
  6. Collect data
  7. Analyse data

The Pareto Principle is also known as the 80/20 rule. It suggests that in anything, a few (20 percent) are vital and many (80 percent) are useful.

  • States that, for many events roughly 80% of the effects come from 20% of the causes
  • Examples:
    • 20% of the people own 80% of the world’s wealth
    • 80% of your time is spent on 20% of staff
    • 80% of the time you walk on 20% of your carpet
  • Suggests that teams need to focus 80% of their energies on the 20% that matters